Pneumonia Flashcards
is the result of an inflammatory process that primarily affects the gas exchange area of the lung.
Pneumonia, or pneumonitis with consolidation,
This process of fluid transfer is called
effusion
move into the infected area to engulf and kill invading bacteria on the alveolar walls.
Polymorphonuclear leukocytes
Polymorphonuclear leukocytes move into the infected area to engulf and kill invading bac- teria on the alveolar walls. This process has been termed ______
surface phagocytosis
If the infection is overwhelming, the alveoli become filled with fluid, RBCs, polymorphonuclear leukocytes, and macrophages. When this occurs, the lungs are said to be ______
consolidated
Atelectasis is often asso- ciated with patients who have _____
aspiration pneumonia
The major pathologic or structural changes associated with pneumonia are as follows: / Anatomic Alterations of the Lungs
• Inflammation of the alveoli
• Alveolar consolidation
• Atelectasis (e.g., aspiration pneumonia)
Causes of pneumonia include
bacteria, viruses, fungi, protozoa, parasites, tuberculosis, anaerobic organisms, aspiration, and the inhalation of irritating chemicals such as chlorine.
Pneumonia is an ______ disease because its symptoms vary greatly, depending on the patient’s specific underlying condi- tion and the type of organism causing the pneumonia.
insidious
The terms __________ often refer to the anatomic location of the inflammation
bronchopneumonia,
lobar pneumonia,
interstitial pneumonia
______ is characterized by a patchy pattern of infection that is limited to the segmental bronchi and surrounding lung parenchyma.
Bronchopneumonia
_______ usually involves both lungs and is seen more often in the lower lobes of the lung.
Bronchopneumonia
_______ is a widespread or diffuse alveolar inflammation and consoli- dation.
Lobar pneumonia
________ is typically the end result of a severe or long-term bronchopneumonia in which the infec- tion has spread from one lung segment to another until the entire lung lobe is involved.
Lobar pneumonia
_______ is usually a diffuse and often bilateral inflammation that primarily involves the alveolar septa and interstitial space.
Interstitial pneumonia
the ________ do not migrate into the alveoli—they remain in the alveolar interstitial spaces.
polymorphonuclear leukocytes
____ cause interstitial pneumonias.
Mycoplasma pneumonia and other viruses
most interstitial pneumonias cause only ______ and usually resolve without consequences.
minor permanent alveolar damage
Risk Factors for Pneumonia
• Age over 65 years
• Aspiration of oropharyngeal secretions
• Viral respiratory infections
• Chronic illness and debilitation (e.g., diabetes melli-
tus, uremia)
• Chronic respiratory disease (COPD, asthma, cystic
fibrosis)
• Cancer (especially lung cancer)
• Prolonged bed rest
• Tracheostomy or endotracheal tube
• Abdominal or thoracic surgery
• Rib fractures
• Immunosuppressive therapy
• AIDS
When both lungs are involved, the condition is sometimes called _______ by laypersons.
double pneumonia
Although the lay term “ _______” has no clinical significance, it is often used to describe a mild case of pneumonia.
walking pneumonia
______ refers to a pneumonia acquired from normal social contact
Community-acquired pneumonia (CAP)
Community-Acquired Pneumonia
• Streptococcus pneumonia
• Staphylococcus aureus (also hospital-acquired
pneumonia)
• Haemophilus influenza
• Legionella pneumophila
• Enterobacteriaceae (Klebsiella pneumonia)
• Pseudomonas aeruginosa (also hospital-acquired
pneumonia)
Community-Acquired Atypical Pneumonia
• Mycoplasma pneumonia
• Chlamydia spp.—C. pneumonia, C. psittaci, C. tracho-
matis, and C. burnetii (Q fever)
• Viruses: respiratory syncytial virus, parainfluenza virus
(children); influenza A and B (adults); adenovirus (mili- tary recruits), human metapneumovirus
Hospital-Acquired Pneumonia (Nosocomial Pneumonia)
• Gram-negative bacilli belonging to Enterobacteriaceae
(Klebsiella spp., Serratia marcescens, Escherichia coli) and Pseudomonas spp., and Staphylococcus aureus (usually methicillin-resistant)
• Ventilator-acquired pneumonia (P. aeruginosa, Klebsi- ella, and S. aureus)
Aspiration Pneumonia
• Anaerobic oral flora (Bacteroides, Prevotella, Fusobac- terium, Peptostreptococcus), admixed with
aerobic bacteria (S. pneumonia, S. aureus, H. influenza, and Pseudomonas aeruginosa)
Chronic Pneumonia
• Granulomatous: Mycobacterium tuberculosis and atypi- cal mycobacteria, Histoplasma capsulatum, Coccidioi- des immitis, Blastomyces dermatitidis
• Candida albicans, Cryptococcus neoformans, and Aspergillus
• Nocardia
• Actinomyces
Necrotizing Pneumonia and Lung Abscess
• Anaerobic bacteria (extremely common), with or without mixed aerobic infection S. aureus, K. pneumonia, Strep- tococcus pyogenes, and type 3 pneumococcus (uncommon)
Pneumonia in the Immunocompromised Host
• Cytomegalovirus
• Pneumocystis jirovecii
• Mycobacterium avium complex (MAC)
• Invasive aspergillosis
• Invasive candidiasis
• “Usual” bacterial, viral, and fungal organisms
(commonly called pneumococcal pneumonia) accounts for more than 80% of all the bacterial pneumonias
Streptococcal pneumonia. Streptococcus pneumoniae
The organism is a gram-positive, nonmotile coccus that is found singly, in pairs (called diplococci), and in short chains.
Streptococcal pneumonia. Streptococcus pneumoniae
There are more than 80 different types of S. pneumoniae. Serotype ____ organisms are the most virulent.
3
Most strains of S. pneumoniae are sensitive to _____ and its derivatives.
penicillin
Streptococcus pneumoniae (S. pneumoniae) is also commonly cultured from the sputum of patients having an acute exacerbation of ______
chronic bronchitis
Staphylococcal pneumonia. There are two major groups of Staphylococcus:
(1) Staphylococcus aureus,
(2) Staphy- lococcus albus and Staphylococcus epidermidis
________ which is responsible for most “staph” infections in humans,
Staphylococcus aureus,
which are part of the normal skin flora.
Staphylococcus albus and Staphylococcus epidermidis,
The ________ are gram-positive cocci found singly, in pairs (called diplococci), and in irregular clusters
staphylococci
____ often follows a predisposing virus infection and is seen most often in children and immunosuppressed adults.
Staphylococcal pneumonia
are a common cause of hospital-acquired pneumonia or noso- comial pneumonia and are becoming increasingly antibiotic resistant—thus the term multiple drug–resistant S. aureus (MDRSA) organisms (some centers shorten this acronym to MRSA).
Staphylococci
_____ is a common inhabitant of human pharyngeal flora.
Haemophilus influenzae
is one of the smallest gram-negative bacilli, measuring about 1.5 mm in length and 0.3 mm in width
H. influenzae (Haemophilus influenzae)
It appears as coccobacilli on Gram stain.
Haemophilus influenzae
There are six types of ______, designated A to F, but only type B is commonly pathogenic.
H. influenzae
_____ is almost always the cause of acute epiglottitis
H. influenzae type B
Additional risk factors for _______ infection include COPD, defects in B-cell function, functional and anatomic asplenia, and human immunodeficiency virus (HIV ) infection.
H. influenzae
__ In July 1976, a severe pneumonia- like disease outbreak occurred at an American Legion con- vention in Philadelphia.
Legionella pneumophila
More than ___ Legionella species have now been identified.
20
Most of the species are free-living in soil and water, where they act as decomposer organisms. The organism also mul- tiplies in standing water such as contaminated mud puddles, large air-conditioning systems, and water tanks.
Legionella pneumophila.
The disease is most commonly seen in middle-aged men who smoke.
Legionella pneumophila
Enterobacteriaceae
(Klebsiella pneumonia) (Friedländer’s Bacillus)
______ organisms have long been associated with lobar pneumonia, particularly in men older than 40 years and in chronic alcoholics of both genders.
K. pneumoniae ( Klebsiella pneumonia )
___ is a gram-negative bacillus that is found singly, in pairs, and in chains of varying lengths.
Klebsiella
It is a normal inhabitant of the human gastrointestinal tract.
Klebsiella pneumonia
_______ is a common nosoco- mial, or hospital-acquired, disease. It is typically transmitted by routes such as clothing, intravenous solutions, foods, and the hands of health-care workers.
K. pneumoniae
______ is a highly mobile, gram-negative bacillus. It is often found in the gastrointestinal tract, burns, and catheterized urinary tract and is a contaminant in many aqueous solutions.
Pseudomonas aeruginosa
leading cause of hospital-acquired pneumonia
This makes ______ a particular problem for the respiratory therapist.
P. aeruginosa
P. aeruginosa grows in a very mucoid colonial form and the sputum from patients with ______ infection is frequently green and sweet smelling
Pseudomonas
The clinical presentation of the patient with ______ is often subacute.
community- acquired atypical pneumonia
The patient typically presents with a variety of both pulmonary and extra- pulmonary findings
Community-Acquired Atypical Pneumonia
The ______ organism is the most common cause of an acquired atypical pneumonia.
mycoplasma
The _____ are tiny, cell wall–deficient organisms
mycoplasma
They are smaller than bacteria but larger than viruses. The pneumonia caused by the mycoplasmal organism is commonly described as a ___
primary atypical pneumonia
The term ____ refers to the fact that (1) the organism escapes identification by standard bacteriologic tests, (2) there is generally only a moderate amount of sputum, (3) there is an absence of alveolar con- solidation, (4) there is only a moderate elevation of white cell count, and (5) there is a lack of alveolar exudate.
atypical
A common symptom of _______ is a cough that tends to come in violent attacks, producing only a small amount of white mucus. Some patients experi- ence nausea or vomiting.
mycoplasma pneumonia
is commonly seen among children and young adults. This type of pneumonia spreads easily in areas where people congregate, such as child-care centers, schools, and homeless shelters.
Mycoplasma pneumonia
Patients with M. pneumoniae often are said to have “_______” because the condition is mild and the patient is usually ambulatory.
walking pneumonia
Chlamydia spp. pneumonia
(Chlamydia pneumonia, Chla- mydia psittaci, Chlamydia trachomatis) and Coxiella burnetii (Q fever)
____ is a type of bacteria that may be found in the cervix, urethra, rectum, throat, and respi- ratory tract.
Chlamydia
___ is also found in the feces of a variety of birds (e.g., parrots, parakeets, lorikeets, cockatoos, chickens, pigeons, ducks, pheasants, turkeys).
Chlamydia
_____ account for about 50% of all pneumonias, and several are associated with a community-acquired atypical pneumonia.
Viruses
Although most viruses attack the upper airways, some can produce _____.
pneumonia
_____ tends to start with flulike signs and symptoms. The early symptoms are a dry (nonproductive) cough, headache, fever, muscle pain, and fatigue. As the disease progresses, the patient may become short of breath, cough, and produce a small amount of clear or white sputum.
Viral pneumonia
______ always carries the risk of development of a secondary bacterial pneumonia.
Viral pneumonia
____ are minute organisms not visible by ordinary light microscopy. They are parasitic and depend on nutrients inside cells for their metabolic and reproductive needs.
Viruses
About 90% of acute upper respiratory tract infections are caused by _____.
viruses
_______ are the most common cause of pneumonia in young children, peaking between the ages of 2 and 3 years. By school age, M. pneumoniae become more prevalent
Respiratory viruses
Common viruses associated with community-acquired atypical pneumonia include
respiratory syncytial virus, parain- fluenza virus (children); influenza A and B (adults); adenovirus (military recruits), and human metapneumovirus.
The ________ is a member of the paramyxovirus group. Parainfluenza, mumps, and rubella viruses also belong to this group.
respiratory syncytial virus (RSV)
_____ is most often seen in children less than 12 months of age and in older adults with underlying heart or pulmonary disease. Almost all children will be infected with ____ by their second birthday.
RSV
___ often goes unrecognized but may play an important role as a fore- runner to bacterial infections.
RSV
_______ infections are most commonly seen in patients during the late fall, winter, or early spring months. Many times the virus is misdiagnosed in older children, who are given anti- biotics that do not produce improvement.
RSV
The ________ are also members of the para- myxovirus group and therefore are related to mumps, rubella, and RSV.
parainfluenza viruses
There are five types of parainfluenza viruses:
types 1, 2, 3, 4A, and 4B.
Types _____ are the major causes of infections in humans.
1, 2, and 3
Type ___ is considered a croup type of virus.
Type 1
Types ___ and ____ are associated with severe infections.
2 and 3
Types 1 and 2 typically occur in the ___, whereas type 3 infection most often is seen in the late ____ and ____ .
fall / spring and summer
_______are transmitted by aerosol droplets and by direct person-to-person contact. The ________ are known for their ability to spread rapidly among members of the same family.
Parainfluenza viruses
The _________ are the most common causes of viral respiratory tract infections.
influenza viruses A and B
In the United States, ________ commonly occur in epidemics during the winter months. Children, young adults, and older individuals are most at risk.
influenza A and B
_____ is transmitted from person to person by aerosol droplets. Often the first sign of an epidemic is an increase in school absenteeism.
influenza viruses A and B
The virus survives well in conditions of low temperatures and low humidity. It also has been found in horses, swine, and birds.
influenza viruses A and B
Epidemiologists fear a pandemic of _____, stating it is an issue of “when” and “where” rather than “if.”
influenza viruses A and B
The _____ serotypes 4, 7, 14, and 21 cause viral infections and pneumonia in all age groups.
adenovirus
Serotype____ has been related to fatal cases of pneumonia in children.
Serotype 7
The _________ is a negative single-stranded RNA virus associated with a family of viruses that also includes respiratory syncytial (RSV) virus and para- influenza virus.
human metapneumovirus (hMPV)
is the second most common cause of lower respiratory infections in young children. The ____ tends to occur in older children and is less severe.
hMPV
Most patients with _____ infection have mild symptoms including cough, runny nose or nasal congestion, sore throat, and fever. More severe cases demonstrate wheezing, difficulty breathing, hoarseness, cough, and pneumonia.
hMPV
Hospital-acquired pneumonia also called
nosocomial pneumonia
______ is an infection whose development is caused by the hospital environment.
Hospital-acquired pneumonia (nosocomial pneumonia)
Common causes of hospital-acquired pneumonias include
Enterobacteriaceae (Klebsiella spp., Serratia marcescens, Escherichia coli),
Pseudomonas spp., and Staphylococcus aureus (usually methicillin-resistant)
Ventilator-acquired pneumonia (VAP)
also called
ventilator-associated pneumonia
A _______ is defined as a pneumonia that develops more than 48 to 72 hours after endotracheal intubation.
ventilator-acquired pneumonia
Common ventilator-associated infections include
P. aeruginosa, Entero- bacter, Klebsiella, and S. aureus
Common pathogenic agents associated with aspiration pneumonia include
anaerobic oral flora (Bacteroides, Prevotella, Fusobacterium, Peptostreptococcus), admixed with aerobic bacteria such as S. pneumonia, S. aureus, H. influenza, and P. aeruginosa.
Aspiration of gastric fluid with a pH of____ or less causes a serious and often fatal form of pneumonia.
2.5
Aspiration of oropharyngeal secretions and gastric fluids are the major causes of _____
anaerobic lung infections
_______ is commonly missed because acute inflammatory reactions may not begin until several hours after aspiration of the gastric fluid. The inflammatory reaction generally increases in severity for 12 to 26 hours and may progress to acute respiratory distress syndrome (ARDS), which includes interstitial and intraalveolar edema, intraalveolar hyaline membrane forma- tion, and atelectasis.
Aspiration pneumonitis
The clinical picture he described is now known as ______ and is usually confined to aspiration pneumonitis in pregnant women.
Mendelson’s syndrome
_______ is broadly defined as the pulmonary result of the entry of material from the stomach or upper respiratory tract into the lower airways.
Aspiration pneumonia
There are at least three distinctive forms of aspiration pneumonia,
- Toxic injury to the lung (such as that caused by gastric acid)
- Obstruction (by foreign body or fluids)
- Infection
_______ is the regurgitation of stomach contents into the esophagus. ____ causes disruption in nerve-mediated reflexes in the distal esophagus, resulting in alteration of the primary and secondary peristal- tic wave and reflux.
Gastroesophageal reflux disease (GERD)
Normal swallowing mechanics has four phases, as follows:
- Oral preparatory
- Oral
- Pharyngeal
- Esophageal
_______ is the result of an abnormal swallow that can involve the oral, pharyngeal, and esophageal phases.
Dysphagia
_______ is defined as aspiration that does not evoke clinically observable adverse symptoms such as overt coughing, choking, and immediate respiratory distress.
Silent aspiration
______ is typically a localized lesion in patients with a normal immune system, with or without regional lymph node involvement.
Chronic pneumonia
is by far the most important organism within the category of chronic pneumo- nias.
Tuberculosis
is a slender, rod-shaped aerobic organism.
M. tuberculosis
C. albicans infection of the mouth is called ______ ; it is characterized by a white, adherent, patchy infection of the membranes of the mouth, gums, cheeks, and throat.
thrush
______ proliferates in pigeon droppings, which have a high nitrogen content, and readily scatters into the air and dust.
Cryptococcus neoformans
is found in soil, vegetation, leaf detritus, food, and compost heaps.
Aspergillus
____ are gram-positive, rod-shaped bacteria that can be found worldwide in soils that are rich with organic matter. It has a total of 85 species.
Nocardia
______ species are normally present in the gingival area and are common opportunistic pathogens of humans, particularly in the oral cavity
Actinomyces
______ and ____ refers to localized pus formation and necrosis within the pulmonary paren- chyma, resulting in one or more large cavities
Necrotizing pneumonia and lung abscess
__________ , a member of the herpesvirus family, is the most common viral pulmonary complication of AIDS.
Cytomegalovirus (CMV)
______ infection commonly coexists with Pneumocystis carinii infection.
CMV
Pneumocystis jirovecii also known as
Pneumocystis carinii
______ is an opportunistic, often fatal, form of pneumonia seen in patients who are profoundly immunosuppressed.
Pneumocystis jirovecii
_____ organism has been identified as a protozoan, recent information suggests that it is more closely related to fungi.
Pneumocystis
______ can normally be found in the lungs of humans, but it does not cause disease in healthy hosts, only in individuals whose immune systems are critically impaired.
Pneumocystis
________ is the major pulmonary infection seen in patients with AIDS and HIV infection.
Pneumocystis pneumonia
______ pneumonia was seen pri- marily in patients with malignancy, in organ transplant recip- ients, and in patients with diseases requiring treatment with large doses of immunosuppressive agents.
P. carinii
The early clinical manifestations of _____ in patients with AIDS are indistinguishable from those of any other pneumonia.
Pneumocystis carinii
Typical signs and symptoms include
(Pneumocystis carinii)
progressive exertional dyspnea, a dry cough that may or may not produce mucoid sputum, difficulty in taking a deep breath (not caused by pleurisy), and fever with or without sweats.
The therapist may hear normal breath sounds on auscultation or end-inspiratory crackles.
Pneumocystis carinii
The chest x-ray film may be normal at first; later it will show ________ , which may progress to alveolar filling and “______” of the chest x-ray film. (Pneumocystis carinii)
bilateral interstitial infiltrates / white out
Mycobacterium avium complex (MAC) is a serious opportunistic infection that is caused by the following two similar bacteria:
Mycobacterium avium and Mycobacterium intercellulare.
____ is found in the soil and dust particles. ____ is commonly found in patients with AIDS.
MAC
The mode of infection is usually inhalation or ingestion.
MAC
____ can spread through the bloodstream to infect lymph nodes, bone marrow, the liver, the spleen, spinal fluid, the lungs, and the intestinal tract.
MAC
Typical symptoms of ____ include fever, night sweats, weight loss, fatigue, anemia, diarrhea, and enlarged spleen.
MAC
_____ is a general term used for a wide variety of infections caused by the fungi of the genus Aspergillus.
Invasive Aspergillosis
Most humans inhale _____ spores every day.
Aspergillus
The most common forms ( invasive aspergillosis)
allergic bronchopulmonary aspergillosis,
pulmonary aspergilloma, and
invasive aspergillosis.
_______ is a general term describing fungal infections caused by a variety of species of the genus Candida, most often by ______ , a yeastlike fungus.
Invasive Candidiasis / Candida albicans
These fungi are normally found in the mouth, vagina, and intestines of healthy individuals.
Invasive Candidiasis
_____ infections can involve any part of the body. In some cases, the fungus enters the bloodstream and causes invasive disease affecting internal body organs such as the kidneys, spleen, lungs, liver, eyes, meninges, brain, and heart valves.
Candida
______ are small, pleomorphic coccobacilli. are intracellular parasites possessing both ribonucleic acid (RNA) and deoxyribonucleic acid (DNA).
Rickettsiae
Rickettsia burnetii, also called
Coxiella burnetii (Q fever)
The ____ virus usually causes a benign disease in children aged 2 to 8 years, and complications of _____ are not common.
varicella (chickenpox)
______ virus spreads from person to person by the respira- tory route.
Rubella (Measles)
In 2002, China reported the first case of
severe acute respiratory syndrome (SARS).
Health officials believe that the cause of SARS is a newly recognized virus strain called a _____
coronavirus
The aspiration of mineral oil, used medically as a lubricant, has also been known to cause pneumonitis– _______
lipoid pneumonitis.
______ (also called bird flu and H5N1) is a subtype of the A strain virus and is highly contagious in birds.
Avian influenza A
in _____ in 1997 the first avian influenza virus to infect humans directly was reported.
Hong Kong
Vital Signs
• Increased Respiratory Rate (Tachypnea)
• Increased temperature (bacteria >101° F and viral <101° F)
• Increased Heart Rate (Pulse) and Blood Pressure
• Chest Pain (Pleuritic) and Decreased Chest Expansion
• Cyanosis
• Cough, Sputum Production, and Hemoptysis
Initially the patient with pneumonia usually has a nonproductive _____ cough.
barking or hacking
Chest Assessment Findings
• Increased tactile and vocal fremitus • Dull percussion note
• Bronchial breath sounds
• Crackles
• Pleural friction rub (if process extends to pleural surface)
• Whispered pectoriloquy
Chest Radiograph
• Increased density (from consolidation and atelectasis)
• Air bronchograms
• Pleural effusions
Clinical Manifestations of Pneumonia
Computed Tomography
(CT) Scan
The treatment of pneumonia is based on
(1) the specific cause of the pneumonia, and (2) the severity of symptoms demonstrated by the patient.
_______ the first line of defense is usually an antibiotic prescribed by the attending physician
bacterial pneumonia
______ that may be treated with antiviral medications, the recommended treatment is usually the same as for the flu—bed rest and plenty of fluids. In addition, over-the-counter medications are often helpful to reduce fever, treat aches and pains, and depress the dry cough associated with pneumonia.
viral pneumonias
________, hospitalization may be required.
severe pneumonia
_______ is used to treat hypoxemia, decrease the work of breathing, and decrease myocardial work.
Oxygen therapy
______ may be administered to attempt to offset the atelectasis associated with some pneumonias,
Lung expansion therapy
Diagnostic and therapeutically, ______ may be used if a pleural effusion is present
thoracentesis
From a diag- nostic standpoint, fluid samples may be examined for the following:
• Color
• Odor
• RBC count
• Protein
• Glucose
• Lactic dehydrogenase (LDH)
• Amylase
• pH
• Wright’s, Gram, and acid-fast bacillus (AFB) stains
• Aerobic, anaerobic, tuberculosis, and fungal cultures
• Cytology
Therapeutic _____ may be used to encourage lung reex- pansion when atelectasis is part of the clinical presentation.
thoracentesis
Croup or
(Laryngotracheobronchitis)
Viral disorder resulting in subglottic swelling and obstruction
Croup (Laryngotracheobronchitis)
Common cause: Parainfluenza virus
Croup
Croup (Laryngotracheobronchitis)
Clinical Manifestations:
➢ Inspiratory and Expiratory stridor
➢ Barking cough
➢ Dyspnea, cyanosis, exhaustion, and agitation
Mild stridor (occurs on exertion, no cyanosis):
treated at home
Stridor at rest (harsh breath sounds, suprasternal retractions, cyanosis on room air):
hospitalization
Mild to moderate croup:
cool mist therapy with or without O2
Croup treatment
• Corticosteroids, Epinephrine, and Budesonide
• Intubation and mechanical ventilation
• Heliox
are generally transmitted by aerosol from a cough or sneeze of an infected individual
Streptococcal pneumonia
